South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

L.A. Times had an article about the obvious importance of staffing in providing quality care in nursing homes.  The cornerstone to quality care in a nursing home is staffing.  Those with larger staffs tend to have less turnover, more stability and are more likely to meet the needs of all the residents.

"There is some very persuasive data showing staff simply can't perform all of the responsibilities they have unless there is an adequate ratio of staff to residents," says Janet Wells, policy director for the National Citizen's Coalition for Nursing Home Reform, a reform-activist-advocacy organization.  Homes should be staffed to provide at least 3 1/2 to four hours of care per resident in a 24-hour period, says Larry Minnix, chief executive of the American Assn. of Homes and Services for the Aging, a nonprofit organization that represents not-for-profit elder-care facilities. Some may need to offer four to five hours daily depending on the conditions of the residents.

To assess staffing levels, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, recommends visiting at a time when a facility is most likely to have maximum staff on duty (like at lunch, the biggest meal of the day).  Telltale signs of understaffing include diners with food trays who are not eating because they are not receiving necessary assistance, residents sitting idly in common areas or their rooms with nothing to hold their attention, call buttons going unanswered, and development of pressure ulvers.

Visiting during mealtime is also a good way to gauge food quality. Weight loss can be dangerous to the elderly, so food should look and smell appetizing.  Some of the more progressive homes have buffet lines rather than the "school lunchroom program," in which residents shuffle through with trays, Minnix says. "Food is the most looked-forward-to institution for many people, especially those confined to a home," he says. "You should ask about snacks and what kind of weight loss-weight gain program they have."

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The Times Union had an article about a nursing home failing to respond to call bells leading to residents soiling themselves and losing their dignity, or trying to get up unassisted and increasing the chances of falling.  Residents at Glendale Home were forced to wait to use the bathroom, sometimes so long that they relieved themselves in their beds or on the floor, because of a shortage of workers. The nursing home received a $20,800 federal fine.

In September 2008, six residents of the Glendale Home recounted for Health Department interviewers how they felt humiliated when no one answered their call bells for help getting to the toilet.

"We definitely had that deficiency in that period of time," said Schenectady County spokesman Joseph McQueen. He said the facility in Scotia redeployed staff to handle the workload after a study that helped determine when call-bell use was highest.  Additionally, he said, staff attended "dignity" training and the nursing home surveyed residents to ensure the bathroom problem had been addressed. No additional workers were hired.

Certified nurse aides and other employees admitted that on certain days the facility was short-staffed, sometimes to the point that residents were also not turned in their beds increasing the risk of pressure ulcers, and not bathed frequently enough.  Inspectors learned about problems encountered by one resident who had lived at the nursing home for only a month and needed the assistance of two staff members and a mechanical lift to get out of bed.

"She stated that sometimes staff would become angry with her for calling out when they were so busy and tell her she would have to wait," the inspector reported after speaking with the resident and her daughter. "She also stated that when she was waiting for help she would be in pain from the urgency of needing to void. The resident said that on several occasions she had wet herself while waiting for the staff and that she was mortified and embarrassed that she wet her bed."

The state inspectors said they observed another resident who was unclothed from the waist down as he tried to use a bed pan. The resident later said he was yelling out for someone to close the door to his room, the report said.

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The Lexington Herald-Leader had an article about a recent lawsuit filed against a nursing home with a history of neglect and violations.  The facts behind the lawsuit suggest that the nursing home's failure to assess the respiratory condition of a 54-year-old man led to his death after a six-day stay.   The Winchester Centre for Health and Rehabilitation has faced numerous state and federal sanctions in the past two years and was threatened with the loss of Medicare and Medicaid funding.

On Jan. 25, 2008, William Baker was admitted to the nursing home.  The facility failed to assess and monitor Baker's respiratory condition or to suction him. Baker developed breathing problems and was transferred to a Lexington hospital where he died on Jan. 31, 2008.  "The lack of care and attention caused Mr. Baker to suffer in a most traumatic fashion and ultimately die," the lawsuit said.  The lawsuit also the said the facility "established staffing levels that created recklessly high nurse/resident ratios."

The lawsuit is the latest in a series of problems for the facility, which in 2008 received two type A citations — the most serious the state can give. One, in August, was for not calling a doctor when a man lost more than 87 pounds in 19 days. At the end of the 19 days, the man was found unresponsive and was taken to the hospital, according to the citation from the Kentucky Cabinet for Health and Family Services

A second type A citation was issued Jan. 12 after a patient received the wrong dose of an anti-seizure medication for 40 days in November and December, an error that wasn't discovered until the patient suffered a seizure.  The facility didn't have a system to make sure that medications were administered properly, according to the Jan. 12 citation.

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McKnights Long Term Care had a great article on a study that proves the importance and necessity of one-on-one supervision, exercise, and encouragement when feeding residents in a nursing home.  Because of prevalent understaffing in the nursing home industry, most nursing homes do not or cannnot provide enough staff to make sure that the residents are eating enough nutritious foods.

Supervision and encouragement during meals has been proven to reduce the occurrence of unintentional weight loss among long-stay nursing home residents according to the Journal of the American Geriatrics Society.  Vanderbilt University researchers assessed the unintentional weight loss of 76 nursing home residents.

Half of the group received additional attention during mealtime while the other half served as a control group.  Researchers noticed that 52% of residents maintained their weight when they were part of the extra attention group. That compares with 28% of residents in the control group.  Researchers suggest that groups of three or four residents per staff member during mealtimes are more practical and just as effective as one-on-one care.

The new study found that the combination of light exercise and specific nutritional supplements could help keep seniors fit for a longer period of time.   Researchers at Manchester Metropolitan University in England divided 60 seniors into two groups. One group performed moderate exercise once a week and the other performed high resistance exercise twice a week. Within those two groups, some received carbohydrate and protein supplements before and after exercise; some did not.   While all groups showed improved muscle mass and overall strength at the end of the 12-week trial, the most striking results came from the light exercise group that received supplements, according to the study.

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A jury found Life Care Centers of America guilty of negligence. The jury awarded $1.5 million in compensatory damages to the family of a former resident who died as a result of the nursing home's neglect and negligence.

Life Care Centers of America was sued by Dennis Matthews, son of the late Verdie Matthews. He proved the nursing home allowed Mrs. Matthews to develop severe dehydration and malnutrition which caused her death. 

Thomas Hornbuckle, attorney for Matthews, alleged the nursing home intentionally acted recklessly by falsifying fluid and nutrition records of Mrs. Matthews. Hornbuckle said evidence and witnesses had proved Life Care acted negligently and was at fault in the death of Mrs. Matthews.

Mrs. Matthews, 83, was a resident of the facility from the beginning of April 2006 to May 1, 2006. She was admitted to Bradley Memorial Hospital on May 1, 2006, and died on May 4, 2006. Medical records indicate at the time of admission to the nursing home Mrs. Matthews weighed 105 pounds. At the time of her death four weeks later, she weighed 92 pounds.

Attorney Steve Hornbuckle confirmed the jury found Life Care Centers guilty of negligence in contributing to the death of Mrs. Matthews.   The jury also found the nursing home acted "recklessly," according to Hornbuckle.

The jury will reconvene Monday morning to deliberate on awarding punitive damages. Both attorneys will be given a chance to argue the case.

Jury will decide punitve damages.

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Kathleen Glanville, a writer for The Oregonian, wrote an article about a $900,000 verdict for a resident who was treated ridiculously bad by a nursing home.  The jury ruled that an 86-year-old woman with Alzheimer's disease suffered a loss of dignity when Lake Oswego police forced her to the floor of her nursing home and handcuffed her.   The jury awarded more than $900,000 to the family of the late Elvera Stephan for the way she was treated the night of April 13, 2006, at The Pearl at Kruse Way in Lake Oswego.

The jury agreed that Avamere Health Services, the corporate owner of the Alzheimer's care center, had acted with malice or reckless indifference.  Stephan's children moved her into the Alzheimer's care center in early April 2006 after her husband became seriously ill and was hospitalized. Within a few days she became agitated, wandering the nursing home barefoot in her pajamas, confused and, according to her caretakers, dangerously aggressive.

The staff notified a registered nurse in another part of the nursing home, who called the woman's doctor for guidance. He said Stephan should be taken to the emergency room for evaluation and medication.  The nurse called 9-1-1 to summon an ambulance, and because she told the emergency dispatcher that the patient was extremely aggressive, Lake Oswego police responded as well.

But jurors said she didn't look dangerous on a surveillance video from the nursing home. She was gesturing with a telephone receiver but didn't try to hit anyone with it.

Two officers forced the elderly woman to the floor, where they rolled her onto her stomach and handcuffed her hands behind her back. She remained on the floor on her stomach for six minutes until paramedics put her on a stretcher and took her to the hospital, according to Kocher. She returned to The Pearl the next day, when a nurse reported that her wrists were bruised.

A state investigator found the nursing home at fault for failing to assess the woman's condition and intervene in a timely manner.   Stephan's son, James, testified that he didn't learn about what had happened to his mother for six days, when he was told by the relatives of another patient at The Pearl.

The video of the police subduing the woman was played for the jury.   Kocher had asked the jury to award Stephan's family $1 million to send a message to corporations that care for Oregon's elderly and vulnerable.

The jury agreed on $4,200 in economic damages -- the cost of Stephan's shared room for a month -- and $400,000 in noneconomic damages. The jury then awarded $500,000 in punitive damages. Under state law, 60 percent of punitive damages go to the state victims assistance fund.

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